Infection and pain+++

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Thanks rowdy, i will have my operation on jan. 6th . Remember i had to go back to work for 30 days to save my job, the pain is so bad i can't stand it some days till i get back home and get off my legs. I do heating and cooling, mechnical, for a university here in michigan.. Wish i had a desk job. Does anyone think i could get social security disibility with both knees being replaced and the problem with staph infection ??? Thanks john c
 
Hi John,

If you work for a Michigan Public University, I'd say the odds are high you also have long-term disability (LTD) insurance. Have you checked into this? It is usually more lucrative than social security disability. Also, if you are on the regular LTD, they usually help you get the social security disability because it "offsets" their costs (In other words, they reduce the amount they pay by the amount social security pays.). It's worth a call to your union or HR office to see if you have such coverage.

Good luck!
 
Hi all
I went back to the GP and had more bloods done. Eveything in the bloods is returning to normal. Yesterday I had some dental work done (I had this planned b4 TKR surgery). I have found another possible source for the infection a I had an absess on the root of one of the teeth removed. The doctor does not think I need to see the OS and examined the area that is swollen and said he thinks it will self reolve as its ?joint fluid.
My day goes a bit like this I get up and dont need crutches then by about 1pm am on crutch as I head home then when IM HOME I sit with leg up on the bed and the swelling and pain decreases with this.
Budafli
 
Well, I am truly delighted about that. But you are having a good course of antibiotics after your dental work, aren't you? You do know that for ever after you need to have at least three weeks of a broad spectrum antibiotic even if you are only having your teeth cleaned, don't you? This is to stop a load of bugs that might be dumped into your system from your teeth getting to your knee and starting an infection. I cannot stress how this is so very important a prophylactic protocol. Your surgeon will confirm what I have said.
 
You do know that for ever after you need to have at least three weeks of a broad spectrum antibiotic even if you are only having your teeth cleaned, don't you? This is to stop a load of bugs that might be dumped into your system from your teeth getting to your knee and starting an infection. I cannot stress how this is so very important a prophylactic protocol. Your surgeon will confirm what I have said.

Interesting, in the States it appears a pretty common protocol for implants seems to be a gram of cefloxin an hour before the procedure. That's what I got from a urologist before my TKR because I had a pacemaker and he was poking me in bad places. After my TKR thats the same thing my orthopod prescribed for dental prophylaxis
 
Me too....but since I am allergic, I have a different antibiotic. But it's just a large dose about an hour before the procedure. Josephine....what do you think of that???
 
Hi all
I went back to the GP and had more bloods done. Eveything in the bloods is returning to normal. Yesterday I had some dental work done (I had this planned b4 TKR surgery). I have found another possible source for the infection a I had an absess on the root of one of the teeth removed. The doctor does not think I need to see the OS and examined the area that is swollen and said he thinks it will self reolve as its ?joint fluid.
My day goes a bit like this I get up and dont need crutches then by about 1pm am on crutch as I head home then when IM HOME I sit with leg up on the bed and the swelling and pain decreases with this.
Budafli

You know, I can appreciate what your GP is saying and the tooth infection certainly could be part of the problem in my opinion. But....if you are in pain like you say, I think you still really need to discuss that with your surgeon. Can you make the appointment with him/her directly or do you have to get a referral from your GP? Either way, if it was me....I'd insist on an appointment just to be sure everything was fine. I made the mistake following a "simple" arthroscopic procedure of not going back to see the doctor quickly enough and suffered through a lot of needless pain. There is no reason you have to hurt this badly and you certainly don't want to end up with a problem because you didn't get the surgeon's opinion of what is going on....at least that's my opinion.
 
Hi there
for the dental work I had to have 4 amoxicylan 1 hour before and two six hours after the extractions.
As for the pain I was thinking that cant be normal at 8 weeks but the physio says it is? Its not in the joint but down both sides under the scar and sometimes up the top.
Usually here the GP has to refer you to the specialist at the hospital.
Budafli
 
Well, from what I understand, here in the UK the regime is to have 2 weeks antibiotics, preferably prior to the dentistry but I couldn't find any website to support this so seems you are right!

However, I also found this interesting article.


Joint Replacement Patients Need Antibiotics Before Some Dental and Surgical Procedures


For most people, going to the dentist is not really something to which we give a lot of consideration, but for those with total joint replacements going to the dentist is reason for precaution.

Your mouth is home to many naturally occurring bacteria. These germs, when they remain in your mouth are not a problem. However, if introduced onto the blood stream, they can find their way to not so friendly places. For the average person, these wayward bacteria are no problem as the immune system deals with them swiftly. For someone who has a joint replacement or possibly other prosthetic implants, these bacteria become a reason for concern.
The materials that joint replacements are made of are non-reactive or inert. This means that they do not activate the immune system of the body. Essentially, the body accepts these materials as its own. However, because they are a foreign substance and don't have a bloody supply, they are susceptible to infection.

Bacteria may attach themselves to the metal and seal themselves off. Once they have done this, it is impossible for the immune system or for antibiotics to get at them. This means we have to prevent them from getting there in the first place!

Because prevention is the best medicine, it's important to protect yourself and your joint replacement when visiting the dentist. Regardless of the type of dental work being done, even a routine cleaning can cause bacteria to be introduced into the bloodstream. "To prevent the spread of bacteria we recommend a specific protocol (see below) of antibiotics before and after all dental work and also all surgical procedures, including tests that penetrate the skin," said John Hillyard, M.D. of Texas Center for Joint Replacement. Antibiotic protocols should be shared with your doctor or dentist. If you have questions contact your orthopaedic surgeon regarding your specific condition.

While the likelihood of an infection occurring as a result of a dental visit is remote, the investment in both time and money is a small one and well worth it.

Recommended Prophylactic Regimen for Dental, Oral or Upper Respiratory Tract Procedures
Standard Regimen
Amoxicillin 3.0 g. orally 1 hr. before procedure; 1.5 g 6 hrs. after initial dose

Amoxicillin/Penicillin Allergic Patients
Erythroycin or Cindamycin
Erythromycin Ethylsucciante,
800 mg, or Erythromycin stearate, or 1.0 g orally 2 hrs. before procedure
300 mg orally 1 hr. before procedure, 150 mg 6 hrs after initial dose.


Recommended Prophylactic Regimen for Genitourinary or Gastrointestinal Procedures


Standard Regimen

Ampicillin, Gentamicin, and Amoxicillin Intravenous or intramuscular administration of ampicillin, 2.0 g, plus gentamicin, 1.5 mg/kg (not to exceed 80 mg) 30 min. before procedure; followed by amoxicillin, 1.5 g orally 6 hrs. after initial dose; alternatively, the parenteral regimen may be repeated once 8 hrs. after initial dose.

Ampicillin/Amoxicillin/Penicillin Allergic Patients
Vancomycin and Gentamicin Intravenous administration of vancomycin, 1.0 g over 1 hr., plus intravenous or intramuscular administration of gentamicin, 1.5 mg/kg (not to exceed 80 mg) 1 hr. before procedure; may be repeated once 8 hrs. after initial dose.

Antibiotic Guidelines for Total Joint Replacement Patients Antibiotic Recommended
(call dentist or surgeon if prescription required)
  • Ingrown toenail (infected)*
  • Esophageal dilation
  • Gallbladder surgery
  • Cystoscopy
  • Vaginal hysterectomy
  • Dental procedures known to induce gingival or mucosal bleeding, including professional cleaning.
  • Tonsillectomy and/or adeniodectomy
  • Surgical operations that involve intestinal or respiratory mucosa.
  • Urethral catheterization if urinary tract infection is present*
  • Urinary tract surgery if urinary tract infection is present*
  • Incision and drainage of infected tissue*
  • Vaginal delivery in the presence of infection*
Antibiotics Not Recommended

  • Shedding of primary teeth
  • Tympanstomy tube insertion
  • Endotracheal intubation
  • Cardiac catheterization
  • Cesarean section
  • Dental procedures not likely to induce gingival bleeding, such as simple adjustment or orthodontic appliances or filling of above the gum line
  • Infection of local intraoral anesthetic (except intraligamentary injections)
  • Bronchososcopy with a flexible bronchoscope, with or without biopsy
  • Endoscopy with or without gastrointestinal biopsy
  • In the absence of infection for urethral catheterization, dilation and curettage, uncomplicated vaginal delivery, therapeutic abortion, sterilization procedures, or insertion or removal of intrauterine devices
  • Electrolysis
  • Skin biopsy/removal of lesions
  • Cataract surgery
Note: this table lists selected procedures but is not meant to be all-inclusive.
* In addition to prophylactic regimen for genitourinary procedures, antibiotic therapy should be directed against the most likely bacterial pathogen.

© 2002-8 Texas Center for Joint Replacement
 
I am going to the dentist today at 1:00. I will take 4 ~ 500 mg Amoxicillin 1 hour before the appointment. I will take none after. The other restriction was I could not have dental work done for a minimum of 3 months following the BTKR procedure.
Best,
Crystal
 
Hi all,
There seems to be a range of views on the subject of antibiotics for dental visits. Josephine, I know you love to research, I wondered if you had come across the American Dental Association and American Academy of Orthopedic Surgeons Advisory statement: Antibiotic Prophylaxis for Dental Patients With Total Joint Replacements. It can be found here http://www.ada.org/prof/resources/pubs/jada/reports/report_prophy_statement.pdf

I am nearly 10 weeks out from a THR and due for a dental checkup in the next few weeks and always have a scale and clean. My surgeon didn’t think antibiotics were needed for that. I rang my dentist and they do the “big dose on the day and then a week’s worth afterwards” method, I didn’t ask about the dosage. I’ll go with the antibiotics on the “better safe than sorry principle” :)

Regards
Monica
 
Interesting article there, Monica. Thank you. And as for BSTS principle, I totally agree with you!
 
Hi everyone
More bloods and xray this week only to told all is well. I rang the hospital and said I cant put up with this level of pain for a minute more! The up shot of this is i HAVE been given an apointment to see the doctor at the hospital today. I will have to be assertive and insist on seeing the OS and not his registrar as often happens there. Truly this level of pain is not any more bearable and far worse than the pain I had prior to surgery. I hesitate to write that as I dont want to stop others having it as many here have attested to its success. My own thought is . The random stabbing pain that comes and goes has me jumping. I am also waking several times at night with the pain, I wake up and I am groaning in pain a I wake.
Regards
Budafli
 
Budafli,
I pray you get some answer today and something to relive your pain. Please let us know how it went.
Judy
 
Re: Infection and pain+++UPDATE

Hi everyone. Wanted to update on progress. I am seeing the OS regularly now and have another appointment in February. It seems there is no infection present in the surgery now and that the joint is not loose. I have had a problem with an episode of reactive arthritis almost right through my body since I last wrote. My R knee is however slowly coming along now and I feel like I have come a long way since I last wrote. My movement is at 120%. I do still have pain - sometimes needing to take pain relief for it. I have found heat helps to sooth, doesnt take the pain away but does sooth it. Looking back I ask myself will I ever have another knee replacement and still the answer for me is absolutely and definately no. I hope I never need a revision in the one I currently have. I wanted to tell the truth here to give another POV to the surgery. I think if I had been adequately prepared, knew of the level of pain I would feel, shown how to get in and out of a bed with the least pain I could have etc I may have found this experience less traumatising. Yes I dont have pain in the left knee anymore and I can walk but has the trauma been worth it for me and my answer is still no. I would encourage those going to have a knee replacement to insist on information prior to surgery and even vist an OT to find out things to do afterwards. Also I have found here in NZ you had to ask for pain relief even though it was charted for you nd no one tells you that! Hence if you dont know you dont ask and the pain gets way out of control. This will have coloured my feelings around having another knee replacement too. I was so happy to be discharged because I had some morphine at home which I used to get the pain under control and then plodded on with the panadol and codiene. I do now feel the pain is in control mostly but this is 4 months after the surgery. Also no one had told me I would need to be off work for at least 6 weeks so I went into the surgery thinking 2 weeks and back to work, what a shock! I am going to write about my experience and send it to the public hospital system here in the hope that the system here will change to fully inform people which is supposed to do but failed to in my case. I will also put this website in that in the hope it will be handed out to others. I know my surgery happened fast because they feared needing to do and emergncy knee replacement - ie told on Friday to be at the hospital monday for pre op and surgery on tuesday but I still think information shoud have been given. I take some responsibility in that I should hve asked but I didnt expect the MRI to show what it did and the haste with which surgery needed to be done. This forum has really been a lifesaver for me, I was so relieved to hear others talk of the pain and that it had gotten better, I would never have wated to live with that level of pain forever. I will keep dropping in but wanted to post to update everyone and to lay out how I would feel about another knee replacement.
Cheers and grateful thanks to you all
Lynda
 
Oh Lynda - that is such a shame, that you don't feel it was all worth it. Perhaps it's early days and you will feel differently later. But I am so pleased it wasn't loose or infected. What a relief!

However, you said 'here in NZ' but your locator says United States. Is that an error or are you just presently domiciled in NZ?
 
I too noticed the NZ reference. As I was reading this horror story, I could not imagine this kind of treatment from any American doctors. They would be much too afraid of a law suite.
 
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